Sunday, January 27, 2008
News, Health + Fitness

Athlete killer

 

By Mark Woolsey

Last November, Toronto Blue Jays pitcher Joe Kennedy and Olympic runner Ryan Shay, both 28, died suddenly despite being in seemingly excellent health.

Chattahoochee High School football star Ryan Boslet suddenly dropped during a 2003 football drill. Atlanta Hawks center Jason Collier awoke, struggled to breathe, turned blue and was dead on arrival at a suburban Atlanta hospital in October 2005.
    
Autopsies showed that Boslet was felled—and perhaps Collier as well—by a silent killer with a tongue-twisting name: hypertrophic cardiomyopathy, or HCM. The condition causes thickening of the heart muscle, which can affect its ability to pump, thus disrupting the heart’s electrical functions, causing arrhythmia and bringing things to a dead stop.
    
It’s estimated that the condition impacts one in 500 in the general population. But cardiologists say they’re seeing it pop up more frequently, and they’re not sure why.
    
“It tends to run in families,” says Winston Gandy, a cardiologist at Piedmont Hospital in Atlanta. “With high levels of physical activity, you get ventricular fibrillation or an electric short-circuit of the heart. This condition tends to be most risky at high levels of physical activity, and basketball and football is what we tend to associate with this form of sudden cardiac death.”
      
Gandy says the disease disproportionately affects African-Americans—they make up as much as 50 percent of reported cases. Nonetheless, he still can’t say for sure that it’s genetic.
     
“Not enough research has been done,” he says. “But it’s out there. It’s real.”
    
The deaths of some high-profile athletes have raised awareness of the disease, but athletic programs in Georgia and most other states still don’t have comprehensive screening for HCM. By contrast, the Italian government requires every athlete, from students to pro soccer stars, to undergo an EKG to detect potentially fatal heart problems.
    
Athletic organizations in the U.S. have balked in part because of cost considerations. Gandy, the medical director of an Athens-based group called Athletes’ Heartbeat, which screens University of Georgia athletes, says the group has brought costs down to between $50 and $75 for what can be an $800 set of tests, thanks to physicians donating their time to the endeavor.

But cost isn’t the only problem.

Dan Roden, a cardiologist and heart rhythm specialist with Vanderbilt University Medical Center in Nashville, says Vanderbilt has screened its athletes for about a year and a half, and when follow-up tests indicate that a kid can’t play on a team, it can be a big deal.
     
“It’s a pretty small thing—except for the kid who is diagnosed,” he says. “It’s a decision doctors, parents and coaches all get involved in. What happens is that once the colleges become aware of it, they view it as a huge liability.”

Rhoden says that implantable defibrillators might present a possible solution, and that a few pro players have them, “but it’s pretty unusual.”

Other treatments include beta-blockers, which slow the heartbeat and ease its contractive force, reducing such symptoms as chest pains and shortness of breath. Calcium channel lockers and anti-arrhythmic drugs may also be helpful.

Roden says that at Vanderbilt, student athletes are given an electrocardiogram to detect heart rhythm disturbances. If something “the least bit unusual” shows up, they’re referred for what’s called an echocardiogram—an ultrasound that looks at heart-muscle thickness, valve and structural abnormalities. Testing may also screen for a number of other congenital and infection-related heart problems, such as Marfan’s Syndrome, which results in faulty blood vessel walls and perhaps a ruptured aorta, and myocarditis, an inflammation of heart muscles.

Roden thinks HCM may be brought on by intense training as well as a mutated gene. And some authorities say HCM can be acquired as a result of heightened blood pressure and aging. Whatever the cause, Gandy and Rhoden agree that testing for heart issues among young athletes should be standard procedure. The consequences of not testing are just too devastating.

“We lose several athletes a year in Atlanta at the high-school varsity level,” says Gandy. SP